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To ice or NOT to ice? That is the question

As a clinician I am asked quite often if my clients should use ice or heat. Most often my answer is always HEAT. However some of my clients are dumbfounded when I respond as such. Their immediate response is that their previous doctor or physiotherapist said to use ice. Even their grandma told them as kids to always put ice on a fresh injury. Even my mom would tell me its only common sense. But stop and think for a moment, why is ice common sense?

Human beings have existed for hundreds of thousands of years in all parts of the world where ice never existed. How did they possibly survive without ice in the warm climates? They definitely did not have a freezer in the cave next door. Maybe we do not need to ice to heal our injuries?

As a student, the healing process for tissue was the first thing I studied: it has three stages, inflammation, proliferation and remodeling. So, where does ice fit in? Why do we use it so often for almost every little bump? Ice is an anti-inflammatory. So you are probably thinking of course it makes sense since to put ice on our injuries since we also take anti-inflammatories for our headaches. But that does not answer the question about what ice does for our injury.

Let’s discuss what happens, briefly, in the inflammatory process of healing. If you are running down the street and twist your ankle you may notice that almost immediately it begins to swell. This is the beginning of the inflammation stage. Our brain is telling our blood vessels to dilate to allow more blood to flow to the injured site. All of this blood is what causes the swelling. This blood is filled with oxygen and the cells that clean away the debris as a result of the injured tissue. Doesn’t the body sound amazing?

Ice, being an anti-inflammatory, does the opposite. It constricts the blood vessels thereby preventing the blood to flow properly to the site of healing. Thus the debris is not properly removed and then the next stage of healing also does not occur properly. Doesn’t that sound horrible?

So where is the evidence? An experimental study in 2011, the best type of study that can be done, actually revealed that icing had negative effects on the healed tissue 28 days later (Takagi et al 2011). Many systematic reviews have also revealed that ice had no effect on swelling or range of motion in patients after ACL repair surgeries but did lower pain temporarily (Raynor et al 2005). There are many more studies that suggest ice has little to no effect on other surgeries and even negatively impact our performance if used for delayed onset muscle soreness (Bleakley et al 2012).

I’d like to end this blog by just reminding everyone that just because it was the way things were done in the past does not make it right. Even with all these studies physicians, coaches, and even physiotherapists are still reluctant to change. RICE (rest, ice, compression and elevation ) has been replace by POLICE ( protect, optimally load, ice, compression and elevation) but now it’s time to move onto another acronym – METH ( movement, elevation, traction and heat). If we tell one person at a time we’ll eventually get the word out. Please think twice before applying ice to your injury.